Spontaneous left anterior descending coronary artery dissection requiring coronary artery bypass surgery
Rev. bras. cir. cardiovasc
; 32(6): 536-538, Nov.-Dec. 2017. tab, graf
Article
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| LILACS
| ID: biblio-897965
Bibliothèque responsable:
BR1.1
ABSTRACT
Abstract Introduction:
Spontaneous coronary artery dissection is a sudden separation between the layers of a coronary artery wall, non-iatrogenic or trauma related, that has been recognized as an important cause of myocardial infarction.Objective:
To report an emblematic case, in terms of angiographic images, clinical presentation and predisposing factors, whose clinical management failure led to surgical intervention.Methods:
A previously healthy 48-year-old male farmer was admitted to the emergency room complaining of anterior chest pain described as "tearing", which started after physical exertion. Anterior wall ST-segment depression was observed in the electrocardiogram and troponin levels were increased. The patient then underwent coronary catheterization. Angiography showed a tortuous left anterior descending coronary artery with a dissection line involving proximal and middle segments, resulting in mild to moderate luminal stenosis. At first, a conservative approach was chosen. Control cardiac catheterization, 3 months later, showed dissection progression to the distal segment.Results:
The patient was referred to surgical treatment. Internal thoracic artery and a great saphenous vein graft were used to revascularize the target vessels. He had an uneventful postoperative course.Conclusion:
In this report, we describe a typical clinical manifestation of an uncommon cause of acute myocardial infarction. The dissection was started by an extreme physical effort, which is a known triggering factor. Management of these cases is always challenging because there are no evidence-based therapies or guideline-based recomendations.Mots clés
Texte intégral:
1
Indice:
LILACS
Sujet Principal:
Maladies vasculaires
/
Pontage aortocoronarien
/
Anomalies congénitales des vaisseaux coronaires
Type d'étude:
Etiology_studies
/
Guideline
Limites du sujet:
Humans
/
Male
langue:
En
Texte intégral:
Rev. bras. cir. cardiovasc
Thème du journal:
CARDIOLOGIA
/
CIRURGIA GERAL
Année:
2017
Type:
Article